Point-of-Care Ultrasonography for Primary Care Physicians and General Internists

Abstract

Point-of-care ultrasonography (POCUS) is a safe and rapidly evolving diagnostic modality that is now utilized by health care professionals from nearly all specialties. Technological advances have improved the portability of equipment, enabling ultrasound imaging to be executed at the bedside and thereby allowing internists to make timely diagnoses and perform ultrasound-guided procedures. We reviewed the literature on the POCUS applications most relevant to the practice of internal medicine. The use of POCUS can immediately narrow differential diagnoses by building on the clinical information revealed by the traditional physical examination and refining clinical decision making for further management. We describe 2 common patient scenarios (heart failure and sepsis) to highlight the impact of POCUS performed by internists on efficiency, diagnostic accuracy, resource utilization, and radiation exposure. Using POCUS to guide procedures has been found to reduce procedure-related complications, along with costs and lengths of stay associated with these complications. Despite several undisputed advantages of POCUS, barriers to implementation must be considered. Most importantly, the utility of POCUS depends on the experience and skills of the operator, which are affected by the availability of training and the cost of ultrasound devices. Additional system barriers include availability of templates for documentation, electronic storage for image archiving, and policies and procedures for quality assurance and billing. Integration of POCUS into the practice of internal medicine is an inevitable change that will empower internists to improve the care of their patients at the bedside.

Do emergency physicians rely on point‐of‐care ultrasound for clinical decision making without additional confirmatory testing?

“…13 Similar to other studies, they reported that barriers to performing POCUS include the experience and skill of the individual performing the ultrasound examination, availability of training, financial costs, lack of standardized templates for documentation, policies for billing, quality assurance for competency, and image archiving. 13 Another surprising result from this study was that approximately 28% of respondents performed only one ultrasound examination per shift. The safety record of EM-POCUS is very high and we should be substituting less harmful imaging studies such as ultrasound instead of more harmful imaging studies involving ionizing radiation.…”

Point-of-Care Ultrasound in General Practice: A Systematic Review

“…[1][2][3] Evidence supports the idea that adding POCUS to the examination of selected patients leads to improved and earlier diagnosis in a hospital setting. [4][5][6][7] As a result, POCUS has been integrated into the curriculum in several medical schools 8,9 and medical specialist training programs. 10,11 General practitioners are increasingly using POCUS in patient care.…”

Effectiveness of education in point-of-care ultrasound-assisted physical examinations in an emergency department

“…[2] Despite the undisputed advantages of utilizing POCUS, there are several barriers to consider due to challenges related to equipment and technology, experience and skills of the operator(s), availability of documentation templates, electronic storage capability for image archiving, and policies and procedures for quality assurance and billing. [3] …”